Nursing Preceptor program

Please use this web page for the following:

to sign up as a nursing preceptor.
to renew your agreement (resubmit full form – this must be completed every two years).
to update contact information at any time.

Thank you for your interest in serving as a Texarkana College Nursing preceptor. Collected information will not be shared outside of the Health Sciences Division and will only be used to contact you regarding business pertaining to the preceptor program (annual renewal reminder, etc). We look forward to working with you.

Instructions:

view Nursing Preceptor Reference Guide (PDF) and use as a resource.
complete web form below with all required fields & click submit.
you will receive a confirmation email with an attached PDF copy of agreement form.

TC Health Sciences Nursing Program Nursing Preceptor Qualifications / Agreement

Preceptor Information
Name*
First Last
Email*
Enter Email Confirm Email
Contact Number*
Type of Licensure*
State of Licensure*
License Number
Certifications
Highest Nursing Degree Held*
Employer
Agency of Employment*
Area or Department Name*
Manager Name*
Manager Email*
Enter Email Confirm Email
Manager Contact Number*
It is agreed that aforementioned preceptor employed by aforementioned agency of employment will affiliate as a preceptor with faculty in the Health Sciences Division, Texarkana College. The preceptor attests the aforementioned manager is aware and acceptable of preceptor serving in role described. No more than two students at a time will be scheduled with the preceptor. Responsibilities of each participant (faculty, preceptor, and student) are as follows:
Faculty
1. orients students and preceptors to the experience
2. schedules individual students with preceptors
3. helps preceptors and students to identify learning needs and expected outcomes
4. consults with preceptors regularly and as needed
5. participates in the evaluation process
Student
1. identifies and communicates own learning needs
2. prepares for the clinical experience by reading and practicing skills as necessary
3. follows policies and procedures of the agency
4. is accountable for own actions
5. participates in the evaluation process
Preceptor
1. orients the student to the clinical area/agency
2. schedules the student’s daily experiences
3. supervises and teaches the student in the clinical area
4. consults with faculty as needed
5. evaluates the student’s practices
(e-sign) Preceptor Signature /s/*
Date*
MM slash DD slash YYYY
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Nursing Preceptor program

TC Health Sciences Nursing Program Nursing Preceptor Qualifications / Agreement

Preceptor Information

Employer